How to be Happy when you are a Cog in the Wheel by Angela DeBernardo

I’ve been trying to figure out the whole Santa thing. He’s always described as such a happy guy. The twinkling eyes! All those toys! The shaking belly laugh! Do you really buy that? I mean this guy lives in the North Pole, right? And it’s Christmas all the time for him. I don’t think that would leave most people cheerful. After all, there doesn’t seem to be much in the winter season to inspire glee. The trees are barren, the sun is gone by late afternoon and everyone is stressed-out, overscheduled and miserable. Of course, Santa runs the show – and the latest research shows that may be the key to happiness.

For those of us dealing with a medical residency program, the holidays have there own special tortures. Spouses may be at the hospital on Christmas Day. If they are off, they often have to repay the time by doing a series of “every-others” after December 25^th. Even with a completely clear schedule, few medical families have the cash to travel to visit their extended families – or even buy presents for their own children – without relying on credit cards.



Interestingly, it may not be just the lack of money or time that stresses us out during residency. Studies show that a lack of control over your circumstances is a principal cause of stress-related illness. Perhaps the most comprehensive of these is the Whitehall study. In a study of 18,000 British civil servants across ten years, lead investigator Sir Michael Marmot found a clear social gradient in all causes of death. The higher your work status, the less likely you are to suffer heart disease, major cancers, diabetes, or renal failure. The results of this massive study were stunning when they were revealed. Common sense had suggested that upper management types – those making the big bucks – would suffer more stress-related illness like heart disease. In fact, the reverse was found. The underlings on the ladder had higher levels of stress-related illness. Being at the top of the pack protected you from illness. Some of this can be explained by availability of healthcare and lifestyle choices like smoking and diet, but a large portion - in fact the majority -of the data remains a mystery.


These findings don’t surprise me at all. In fact, they mesh with my feeling about medical training completely. All through my husband’s training years, we may have complained about the money and the hours but what we really longed for – what we dreamed about at the end of the road – was control. Control over call schedules. Control over start times. Control over his OR schedule. Now that my husband is out of training, we’ve found that that control is the key to job satisfaction. Dr. Marmot’s study results reflect that perfectly. Lack of control over your life causes major chronic stress – and that stress accounts for a large portion of illness.


We all talk about stress as one entity. Actually, there are many different kinds of stress. We all know this intuitively. It’s stressful to go to a number of different parties in one night. It’s also stressful to go bankrupt. Undoubtedly, these are two different experiences. Lacking control in your life creates a chronic stress state. There may not be any one issue that you can pinpoint as the stressor – it’s just everything. We all know that feeling. This type of stress is particularly bad for your health – most likely because it is ongoing.


In residency, both trainee and family experience almost a complete lack of control. From the moment you enter that match list, your life becomes programmed by the “medicine machine”. The match tells you where you will live. The medical boards decide if requirements will be altered. Residency programs are under no requirement to keep work conditions stable – in fact, simply requiring them to limit hours to 80 hours a week has thrown scheduling off everywhere. Once your family is committed to the medical raining path, many decisions are taken out of your hands. Often, your only choice is to leave a program altogether. Clearly, medical residents and families experience high levels of “bad stress” for years.



Fortunately, some research has been done on dealing with “lack of control” stress. Their findings can be boiled down to four “C’s”: Control, Challenge, Commitment and Community.
Control the Things You Can

There is some real wisdom in the Serenity Prayer. Controlling the things we can and accepting what we cannot can help ease the stress. Try to identify what you can control. Perhaps you need to set limits with your partner about how far you will go for their pursuit of medicine – and get them to agree to limit themselves as well. For me, the sticking point came at fellowship application time. Was I really willing to move to a new locale for 3 more years of training before starting our “real” life?


There were a lot of discussions. Ultimately, I agreed to my husband’s fellowship aspirations because the benefits of fellowship were worth the additional three years. Other families we know decided to stop together at the non-medical spouse’s insistence. They are happy with their decisions as well. It’s important to create shared limits as a couple – and honor them.


Another way to gain control is to live your own life. This advice has been repeated over and over in the medical world. The secret to success as a medical spouse is to “live your own life”. I believe this is because the creation of your own life – independent from medicine – gives you some control day to day. Make your own friends. Set your own schedule. Don’t sit waiting for your spouse to join you – that almost always leads to disappointment in residency.
See It As A Challenge

People who approach adversity as a challenge experience lower levels of stress and depression. When you are faced with a move or an unexpected hurdle, thinking “I can do that!” is far better than whining. Sometimes this approach can help with the little things like being left alone at home with children while your husband picks up extra call – or worse – leave for an away rotation. Of course attitude alone can’t change the world. In fact, the Whitehall Study’s Michael Marmot has stated “We’ve found that if someone is being whipped, it doesn’t help to say take more tranquilizers, try meditation or psychotherapy….what helps is to stop the whipping.” Obviously, Dr. Marmot is familiar with the rigors of medical training!
Make the Commitment

It is easier to manage the time in residency if you share your spouse’s commitment. I know, I know….when you hear “commitment” you’re thinking padded room. Even so, dreaming of the future can be very useful. Sometimes you need to see the goal to keep moving forward. Talk about where you want to be in five years, or ten years. Don’t worry about what’s possible or job markets. Those realities are bound to change by the time you are actually applying for jobs. Figure out how each of you can contribute to your dream. Maybe there are things you could be doing that aren’t obvious. If you’d like to change jobs when your spouse finally settles, maybe you could look into baby steps in that direction. If you’d like to live in a new environment, refine your choice. Daydreams may be good for your health. It always feels better when your researching your possible next destination, doesn’t it?
Find a Community

Nothing relieves stress like social support networks. Sometimes the hospital will have a spouse support group. Check with your husband’s program or the hospital’s medical education office. If not, reach out to your neighbors. Even a chat in the hallway at your child’s school can help. If you can’t find support locally, turn to other sources. The modern age has given us internet support groups – and there are thousands. You can find a group for almost any interest or problem. Reach out. Also, as hard as it is, try to stay in touch with the friends you meet along the training path. It’s difficult to keep up contacts when you’re overwhelmed – but it is well worth a weekly 5-minute phone call. Sometimes making contacts a routine can help to preserve them.


Throwing your fortunes to the wind is an unfortunate reality in medical training. Don’t let it get you down. You may not be able to control the big events in your life now, but you can control the small ones. This holiday season give yourself a gift. Find the little things that make you happy. For me, it’s a cup of premium coffee and a new magazine. Find something you love and indulge. Happy holidays!!